Right now, as I’m using my computer keyboard, it’s connective tissue — the ligaments, tendons and smooth cartilage of the joint surfaces — that gives my wrists and hands the strength and flexibility to perform this complex task.
Connective tissue is literally the stuff that holds our bodies together, the “extra-cellular matrix” within which the cells lie. Other names for this tissue are “basement membrane” and “ground substance,” reflecting its foundational quality. Connective tissue is found throughout the body — in all of the organs, in cartilage, bones, tendons, ligaments, and in the loose areolar tissue that forms sheaths around muscles, nerves and blood vessels. Our bodies wouldn’t be much without connective tissue, so it makes sense to do what we can to nourish and support this under- appreciated wonder.
The most abundant constituent of connective tissue is collagen, of which there are more than 18 different varieties. Elastin, fibrillin and proteoglycans are other important components. Connective tissue is synthesized by a fascinating self-assembly process that involves the formation of long strands of polypeptides that fold into a triple-helix conformation with many cross-linkages. This structure gives connective tissue its tensile strength and elasticity.
In the healthy body there is very little metabolic turnover of connective tissue. For this reason, it may take time for injured connective tissue to heal. When connective tissues break down, the process is initiated by enzymes known as collagenases; they work by cleaving one area of the triple helix, causing the whole thing to unravel. Bone is an exception to the slow turnover rate of connective tissue. Healthy bone is constantly remodeling itself. In growing children, this process can be dramatic and rapid.
Herbs Can Help
The plant world offers rich choices for strengthening, healing and balancing connective tissue. Here are some examples:
Gotu kola (Centella asiatica). This beautiful, leafy perennial’s delicate appearance always surprises me, given its muscular medicinal properties. It is used in India and Indonesia to treat wounds, leprosy, varicose veins, skin conditions, injuries and snakebites. In China, the herb is thought to promote longevity. Modern science indicates triterpenoids as its active constituents, and several studies, including one published in a 1994 issue of the journal Planta Medica, indicate multiple effects on connective tissue, on which gotu kola appears to have a balancing or normalizing effect. The herb has been shown to increase blood flow to connective tissue, to improve tensile integrity of the skin and to enhance production of various connective tissue components.
Scientific studies, dating from the 1950s to the present, have evaluated the clinical effectiveness of gotu kola in a range of conditions, including burns, wound healing, keloids and hypertrophic scars, cirrhosis of the liver, scleroderma, venous disorders and even cellulite. One of the more interesting areas of research is in the treatment of leprosy, where gotu kola was shown as effective as the common drug Dapsone and appeared to inhibit the bacteria causing the disease, as well as to promote tissue healing.
The literature also reports gotu kola’s use in anal fissures, bladder ulcerations, fibrocystic breast disease, lupus, periodontal disease and cellulitis. In all of these conditions, connective tissue health is important. Gotu kola is a safe herb with no toxicity reported for internal use. Skin rash rarely occurs with topical use. Take a standardized extract, 60 to 120 mg daily; dried herb, 2 to 4 grams daily; or tincture, 2 to 4 teaspoons daily.
Hawthorn (Crataegus spp.). This rose relative is an ornamental thorny tree or bush. The leaves, blossoms and berries are used medicinally.
Hawthorn has a complex biochemistry, with active constituents including flavonoids, anthocyanidins and proanthocyanidins, which give the flowers and berries their red color. This herb is extensively studied in Europe, primarily for its beneficial effects on the cardiovascular system.
The herb is known to be a collagen stabilizer. It increases cross-linkage of collagen fibers, thus making the matrix stronger, inhibits enzymes that break down collagen and has anti-inflammatory and antioxidant effects. In the cardiovascular system, hawthorn prevents and heals damage to the inner lining (endothelium) of arteries, and this prevents the formation of cholesterol plaques that attach to areas where the connective tissue-rich vessel is injured or inflamed. Hawthorn has many other benefits to the cardiovascular system and is used in the treatment of specific diseases there. The herb deserves more attention for use in other conditions, such as arthritis, musculoskeletal injuries and bone health. Hawthorn has no known toxicities.
Usual doses are: tea, 3 to 5 grams dried berries or flowers per cup of water, decocted for 10 minutes and drunk three times daily; tincture, 1/2 to 1 teaspoon three times daily; standardized extract, 100 to 250 mg three times daily.
A bonus with hawthorn is its pleasant taste and pretty red color in teas or tinctures. Try it mixed with rose hips or rose petals for an especially beautiful treat.
Echinacea (Echinacea spp.). Most people know this herb for its immune-modulating effects and use in treating infections. Gardeners value the ornamental value of its pink petals and prickly cone-headed flowers. Echinacea also has benefits for connective tissue, primarily through its polysaccharide and flavonoid constituents.
Echinacea promotes tissue regeneration and reduces inflammation after injury by inhibiting hyaluronidase, an enzyme that breaks down collagen. And it stimulates fibroblasts, the cells that initiate connective tissue formation and promote the production of connective tissue components. Echinacea often is used topically in the treatment of wounds, abscesses, burns and varicose ulcers, and it is especially helpful in any condition where infection is involved or immune support is desired. Echinacea is nontoxic. Usual dosages for internal use are: dried herb, 1/2 to 1 gram three times daily; tincture, 1/4 to 1 teaspoon three times daily.
Grape seed and pine bark. These herbs are rich in the flavonoids procyanidolic oligomers (PCOs), which protect connective tissue from damage, prevent its breakdown and reinforce its natural structure. PCOs also are potent antioxidants and anti-inflammatories. Clinical studies, including a 1993 study published in The Lancet, have shown benefit in the treatment of venous insufficiency, varicose veins, eye diseases and atherosclerosis. There are no known toxic effects, and the usual dosage of commercially available capsules is 150 to 300 mg per day.
Catch These Catechins
Green tea (Camellia sinensis) and other herbs, such as cutch tree (Acacia catechu) and gambir (Uncaria gambir), contain flavonoid chemicals called catechins. The effects of catechins on connective tissue include increases in cross-link formation in both normal and abnormal collagen, reduction in enzymes that break down collagen and an overall normalizing effect on collagen formation in various collagen diseases.
Clinical studies (all used purified catechin extracts) on rheumatoid arthritis and scleroderma, including a 1982 study published in the International Journal of Dermatology, show significant benefit with catechin treatment. Another study showed reduction in postoperative adhesions (scar tissue that forms in the abdomen after surgery) in an animal model. Catechins also may reduce postsurgical tissue swelling.
Two studies that caught my eye, published in the journals Connective Tissue Research and South African Medical Journal, involved the treatment of osteogenesis imperfecta with catechins. This is a rare hereditary disorder in which the synthesis of collagen is severely impaired, leading to profound weakness of bones, with recurrent fractures. Catechins were shown to reduce fractures and improve collagen formation in this condition. This made me wonder if catechin-containing herbs such as green tea and other collagen-strengthening herbs might be beneficial in the prevention and treatment of osteoporosis (thinning of the bones, which occurs with aging, menopause and some medical conditions). However, I haven’t seen any studies on this.
Green tea is the catechin-containing herb that is most readily available. For caffeine-sensitive individuals, green tea may be overstimulating because of its caffeine content. Usual doses of brewed green tea are 2 to 3 cups per day. Various green tea capsules and extracts also are available. For cutch tree and gambir, follow product directions. Purified catechins in high doses may cause anemia and low platelet counts and are not appropriate for self-treatment. Dietary sources of catechins include apples and chocolate; minimal amounts are present in legumes and various fruits.
Bilberry (Vaccinium myrtillus). A shrubby perennial that bears a blue-black berry, bilberry is the European relative of America’s blueberries and huckleberries.
The important constituents are the flavonoids anthocyanosides, of which more than 15 are found in this herb. These chemicals have potent collagen-stabilizing effects via cross-linkage with collagen fibers, prevention of oxidative damage and inhibition of collagen-destroying enzymes. They also promote the synthesis of various connective tissue components.
Our eyes are particularly rich in connective tissue, and most clinical studies of bilberry focus on this organ. Bilberry has been shown to improve night vision, as well as to prevent and treat glaucoma, cataracts and retinal degeneration. It also has been shown to be beneficial in diabetes, where it lowers blood sugar and corrects collagen damage associated with this disease.
Bilberry has an affinity for the kidney and is used in some chronic degenerative conditions of the kidney that involve connective tissue damage. Note: Kidney disease can be challenging to treat herbally; please consult an experienced herbalist if you have any degree of kidney failure.
Bilberry has no known toxicity. Commercially, it’s primarily available as standardized extract capsules (25 percent anthocyanosides), and the usual dose is 80 to 160 mg three times daily. For similar health benefits, try fresh or fresh-frozen blueberries or huckleberries. Add 1/2 cup or more of the berries to a morning smoothie or cereal — it’s a great start to the day, as well as an easy and pleasant way to promote connective tissue health throughout the body.
Flavonoids are key nutrients for connective tissue health. They give fruits and vegetables their rich red, blue and purple colors. In addition to blueberries and huckleberries, include blackberries, cherries, plums, cranberries, purple cabbage, red peppers, eggplant and tomatoes in the diet daily for a rainbow of color and flavor. Also important for healthy connective tissue are vitamins C, E, A and B6, plus minerals zinc, copper, boron and sulfur. Sulfur-rich foods include garlic, onions, brassica vegetables, eggs, legumes, nuts and seaweeds.
Lois Johnson, M.D., has a busy primary-care practice in Santa Rosa, California. Herbs are her most commonly prescribed medicines, and she has a full-service herbal pharmacy on site.
The reference list for this article is extensive. If you would like a copy, please send a self-addressed, stamped envelope to “Connective Tissue,” Herbs for Health, 1503 SW 42nd St., Topeka, KS 66609; or e-mail us at firstname.lastname@example.org.